Welcome back everyone, how are y’all feeling? Thanks for joining us this week for another episode of Emergency Minute. This week is Episode 9 – Medical Necessities When Traveling. Before we get started, I wanted to thank each and every one of you for listening, commenting, sharing, and reviewing. The average podcaster lasts only 7 episodes, and I’ve made it to 9. So, I can finally tell my mother that I am slightly above average. A proud moment in my life. Those who don’t follow me on social media yet, I do make some medical humor videos and some other useful educational content so be sure to check them out on TikTok, Instagram, Facebook, and YouTube at Drjparente.
The motivation for this podcast topic was a recent trip to Punta Cana, Dominican Republic. Over the next few minutes I will cover some things to consider when traveling, primarily medical, and give you some helpful tips on how to maximize your enjoyment of your trip, or hopefully at least prevent total disaster. Much of the discussion will be focused on warmer climates, as many of us here in the North head South or seek out warmer climates. I could do an entire podcast on cold weather travels, frostbite, get into things like altitude sickness and things like that. Maybe I should do that? I could do a podcast on the different things that happen to those who climb mountains like Acute Mountain Sickness but then contrast that with people who scuba dive and the bad things that can happen like the bends? Hmmm. I think so.
First and foremost, you have to consider the location. Being an ER doc, I’m a big “safety” guy. There’s 2 types of ER docs out there, those who are super safe from all the badness they see, and those who are completely nuts and jump out of airplanes and climb mountains. Anyone who knows me can tell you that I’m nuts, but I’m also not the jump out of the airplane guy.
So before we pick a destination, I typically will research the safety of the country first. There aren’t many things I credit the government with doing well; however, I will give credit where it is due. And they have created a great travel website travel.state.gov that I use before every trip. They break down their recommendations into 4 categories: 1. Usual precautions 2. Increased precautions 3. Don’t go there unless you have to and level 4. Bruh, what are you doing. So most countries that I travel to (think Caribbean and Europe) are levels 1-3. Some of you may be more adventurous than me and I’m sure you could find some “4s” out there.
But some examples of Level 1 in the Caribbean would be St. Martin, Grand Cayman, Antigua, Anguilla, Grand Cayman; and in Europe would be Iceland, Ireland, Switzerland, Austria, Greece, and Croatia. So these are considered safe places to travel where you just exercise normal precautions. If you go on the website you can actually play around and click on each country and go region by region and gather even more information. Some examples of Level 2, meaning exercise increased precautions: Dominican Republic, Turks and Caicos, Costa Rica, and The Bahamas, and in Europe Italy, France, Germany, and Denmark. Level 3’s which are you really shouldn’t travel unless absolutely necessary would be Jamaica, Honduras, Columbia, Cancun, Cabo and just about all places in Mexico, then overseas Hong Kong, Egypt, China, and many countries in Africa. Finally a few level 4’s, most of which are pretty obvious such as Russia, Ukraine, (duh), Haiti, Iran, Iraq, and Venezuela.
So check out that website because I do think that’s pretty useful. There are some attached links to that website which will connect to travel recommendations by the CDC which I think is helpful, as well.
Now, once you’ve settled upon your destination, I would advise you to do your homework and Google that particular country and see what the requirements are for entry and exit, as every country is a bit different. The Bahamas has a travel visa, Dominican has an E-ticket, Cancun has a tourist visa, etc. If you are traveling and don’t do your homework, you will find yourself standing to the outside of the line to get on the plane in the US, or through customs in a foreign country, with your wife staring a hole through your soul as you frantically try to fill out whatever was needed, and that’s just not a good way for anyone to start their vacation.
It would be impossible for me to cover all of the 195 countries and what medical things should be considered prior to travel; but I would advise that you check the CDC website to get this information well in advance of your trip. There are some very important considerations that you may not be aware of. One of my favorite examples is Costa Rica. Sure, a beautiful country in Central America. Great resorts and beaches.
But did you know that it is recommended you get vaccinated in order to go to Costa Rica? Did you know that you should get vaccinations for Hepatitis A and Typhoid Fever? This is in addition to the normal vaccines, of course. Many people don’t have the Hep A and Typhoid vaccination is not common at all unless you’re a traveler. And yes, Typhoid fever is likely what you died from if you ever played the epic computer game of Oregon Trail!
Did I mention that you are advised to take anti-Malaria medications before your trip, during your trip, and after your trip, as well? Oh, and you should consider a Rabies vaccine, as rabid dogs and other animals are quite common in Costa Rica. Remember that one time you died from Rabies? I’m reminded of The Hangover, “But did you die?!” Other bizarre things in Costa Rica include some terrifying things that can be transmitted via bug bites.
Ever hear of Chagas Disease? AKA American Trypanosomiasis which is a parasitic infection that can be life-threatening. And of course Zika with mosquito bites, as well as Dengue Fever. Then you have sand fly bites that can lead to Leishmaniasis. So yeah, you might want to do a little bit of homework prior to your trip. And I’m pretty sure after this podcast, I’m going to be contacted by the Costa Rica Department of Tourism.
Ok. Medications. What to bring?
I pre-emptively need to state that I am not giving medical advice, as I cannot possibly know your medical history, current medications, kidney function, allergies, etc. So for the purpose of this podcast, I am simply stating some options that you may have, if you are able, to take these medications safely. Furthermore, I would recommend that you schedule an appointment with your family physician to discuss these options prior to taking a trip.
Oh, and don’t wait until the week or month before. As we’ve mentioned on this show numerous times, healthcare is broken. If you call your doctor today you might celebrate another birthday before getting in to see them.
First you need the basics: Tylenol (which is Acetaminophen), Ibuprofen (which is Motrin), or if you prefer the other main NSAID (non-steroidal anti-inflammatory drug) Aleve (which is Naproxen). You’d want these for any aches or pains, headaches, or hangovers. And don’t forget to bring the liquid version if you have children. Side note, you can take Tylenol type products at the same time as NSAIDs. Tylenol is processed through your liver. NSAID’s go through your kidneys. Side note #2 is that you CANNOT take Motrin and Naproxin at the same time. That is double dosing your NSAIDs which can lead to stomach upset, ulcers, can injure your kidneys, amongst other issues.
Alright, what about Aspirin? You can bring that if you prefer for headaches or pain, but you have to be at least 18 years old or you can get something called Reyes Syndrome. Why have you never heard of that? Because most people who reproduce are smart enough to know not to give ASA to a child. Side note #3, the same enzymes that break down Tylenol in your liver are the same ones that process ethanol, or Alcohol, ie your margarita. Therefore, it is not a good idea to be hammered and take Tylenol for your headache or hangover. That can cause liver damage.
I’d also recommend an anti-histamine such as Benadryl or Zyrtec. Allergens have local and regional variability which means there may be things that can flare up your allergies that you are unaware of. Having itchy, watery eyes or a rash or hives can definitely make your trip miserable. Plus the added benefit of having an anti-histamine if you have mosquito bites and such.
Quick story about no-see-ums which are bugs you cannot see that cause smaller bites but very similar to mosquito bites. They are in places like Florida and The Bahamas. When I was there, I was under assault with nearly 60-70 bug bites. You can’t see the damn things so you don’t even know you’re being bit until it’s too late. The good news? Bug spray is fairly worthless against it, as well. Some essential oils can deter them, but for the most part they say the best prevention is simply not being outside at dawn or dusk. Awesome.
Another thing to consider with allergies is if someone in your party has anaphylaxis then be sure to bring your Epipen, as well.
What about stomach medications? Many of you are eating and drinking different foods, perhaps partaking in some adult beverages, so it is quite common to get some gastritis, aka, inflammation in your stomach, aka heartburn indigestion or whatever other common societal word you prefer. For this I’d recommend an H2 blocker such as Pepcid. Now some people will want to bring a PPI (proton pump inhibitor) such as Protonix, Nexium, or Prilosec. What’s the difference? Well, the H2 blocker neutralizes the acid in your stomach right now.
So it will theoretically help your symptoms shortly after you take the medication. Prilosec or Omeprazole and the other PPI’s don’t work like that. They work by decreasing acid production, which means you can’t take these as needed, and you won’t feel a difference right away. You would need to take this medication for days or even weeks before you would notice a difference.
Another thing to consider is that when you go to another country, any country, the bacteria and stuff in the water and food and such is going to be different than your normal flora, so it’s not uncommon to get a little bit of diarrhea. So it would be a good idea to bring Simethicone (AKA Gas-X) for gas and Loperamide (Immodium) to help with any diarrhea. Now remember there’s a difference between diarrhea from changes in the food flora versus diarrhea from an infection such as food poisoning. There’s a name for that and it’s called Montezuma’s revenge! AKA Traveler’s diarrhea. This is usually caused by a bacteria called E.Coli, but can be due to other bugs such as Salmonella, Shigella, Norovirus, Rotavirus, among others.
So this is where you would want to ask your physician for a prescription of Azithromycin, Zithromax. Now the great thing about Zithromax is that it is not only indicated for traveler’s diarrhea, but it can be used for a variety of other common infections such as strep throat, otitis media (inner ear infection – no not external ear infection known as swimmer’s ear), bacterial bronchitis, some skin and soft tissue infections like impetigo, pneumonia, and even dental infections. So it is a good one to have on hand. And if you listened to my last podcast Episode 8 – Medical Myths that just won’t die, then you’ll already know Zithromax doesn’t work for sinusitis. And if you haven’t listened to that episode yet, then I hope you get traveler’s diarrhea.
We used to use Fluoroquinolones such as Cipro for this, but this really should be 2nd line and has other downsides like increased risk of tendon rupture, potential for kidney injury, very risky to use in children, etc. In addition to Gas-X, Immodium, and Azithromycin, you may want to consider pepto-bismol which is kind of a relatively safe, far-reaching medication to take as needed and may help with indigestion and heartburn but also may help with diarrhea, as well.
What else should you ask your family physician for? Zofran is another good option, especially the ODT version (oral dissolving tablet). This is great for treatment of nausea and vomiting. So if your little one gets sick this is a great option to have him/her dissolve this under their tongue and treat the vomiting. If you have a really small one at home, you can even break the tablet in half for half of a dose. This also does work for hangovers for those who drink too much, but one thing to keep in mind is that the most common side effect of Zofran is? Headache. So you may want to consider a dose of Motrin in addition to the Zofran for that hangover. And maybe some pickle juice. And some coconut water.
Side note, you know what is really healthy for you and protects your liver, especially after a night of drinking? That’s right, coffee! So many myths about coffee out there, most of which are not true. But we do know that coffee in the morning after a night of drinking does offer some protection for your liver.
What else? What other types of infections can derail a vacation? Think of dirty water going into places it doesn’t belong, such as your eyeballs and your ear holes. Exactly, conjunctivitis. Now, to get even more advanced here, I’m going to give you a travel tip here that will blow your mind. But I cannot possibly take credit for this one as it was the idea of one of the best pharmacists I’ve ever worked with. He suggested getting a prescription for Ofloxacin Ophthalmic. Why is this genius? Because it treats conjunctivitis (eye infections, aka pink eye) but it can also be used in the ear to treat otitis externa, aka swimmer’s ear.
Depending on how skilled you are at gluing things together, another thing to consider would be bringing some basic wound care supplies with you including some tissue adhesive (aka Dermabond). You can find this anywhere on Amazon online. Again, I’m not recommending that you skip out on seeking treatment of a healthcare professional. If you have a tiny cut you might be able to get away with some glue. What happens to nearly 20% of lacerations? They become infected. So bringing some topical antibacterial ointment is a good idea.
Most people say Neosporin. But I actually don’t like Neosporin as a high number of patients are actually allergic to the neomycin component, as high as 11%. So if you’re applying this to a cut, and it is looking worse everyday, is it because the infection is getting worse, or because the Neosporin is causing an allergic, inflamed reaction, making it look worse? So I would actually prefer Polysporin which just contains the Bacitracin and Polymyxin.
Another thing to keep in mind is that the antidote, meaning the reversal agent for Dermabond, is antibiotic ointment. So if you do chose to use the Dermabond, don’t apply antibiotic ointment for a few days unless you are super concerned about infection and that outweighs the benefits of having the wound closed with tissue glue.
Another thing to add would be Aquaphor. So Aquaphor has been around forever and is a great treatment option for most rashes. It rarely causes any allergic reaction and can be used for many forms of dermatitis, which is basically inflamed skin. It can help with sunburn and just about anything that is dried out or itchy.
Speaking of dried out and itchy, please bring sunscreen. Nothing can ruin a trip faster than being ill-prepared for the sun and forgetting sunscreen. Resorts love to sell this to tourists because they jack the prices up through the roof. At the Hard Rock in Punta Cana, the cost of 1 bottle of sunscreen was anywhere from $35-$50! Another thing to consider is that SPF 30 is about as high as it gets. Yes, 50 is slightly more effective so if you are a relative of casper and burn just looking at the sun, then sure, go ahead with the 50. For the most part, 30 is fine with everyone else. And if you use anything over 50, you are simply paying for marketing. There’s literally no difference after 50. I digress.
I think the last thing I’d recommend is something for motion sickness. Now, you can simply take Dramamine if that has worked for you in the past, but it does make some people drowsy. Or if you are someone who really gets sick on an airplane or if you are going on a cruise and are worried about motion sickness ruining your entire vacation, you can ask your family physician to prescribe a medication called Meclizine AKA Antivert or even a Scopolamine patch.
The last thing I want to address when traveling is the big pink elephant in the room: Covid requirements. Groan. First and foremost, why are we still doing this? Do we have requirements for flu or RSV and returning to a country? With this strain, it has mutated so many times that it is now much less dangerous. Plus, most of the world has gotten this already, had the vaccine, or both, and so there is some immunity that has built up. It’s super annoying but I would recommend that you research wherever your travels take you prior to leaving so you know what you may need to do in order to get there without any major hurdles.
We just went to Punta Cana and did not have to do anything for Covid, nor did we have to do anything on the return trip to the US other than some contact tracing nonsense that American Airlines sent us. Many countries have loosened their requirements for entry which makes sense, as this virus is endemic and not going anywhere anytime soon. Time to start living alongside this virus. As I heard someone early on in the pandemic say, “you cannot legislate a virus,” and they could not have been more correct.
Well, that’s all I’ve got this week, so thank you for joining me for this week’s episode of Emergency Minute. If you like what you’ve been listening to please consider sharing this show with someone you know. You can follow me on any social media platform at Drjparente. And as always, peace love and happiness to everyone out there. Cheers guys!